Overview
Contraindications
Hypersensitivity (exception short-term systemic use for health reasons). For systemic use (by mouth and parenterally): herpetic diseases, systemic mycoses, chickenpox, measles (including recent and recent contact with the patient), strongyloidosis (including if it is suspected), tuberculosis (with an active form and the absence of specific therapy), the state of immunodeficiency (including HIV infection or AIDS), diseases of the gastrointestinal tract (including peptic ulcer, peptic ulcer, diverticulitis, gastritis, esophagitis, recently created intestinal anastomosis), blood system pathology treatment (including congestive heart failure, recent myocardial infarction, arterial hypertension), myastenia gravis, diabetes (also with impaired glucose tolerance), renal / hepatic failure, acute psychosis, during the vaccination.
For the introduction of betamethasone into the joint cavity and the lesion: previous arthroplasty, unstable joints, pathological bleeding, intraarticular bone fracture, infected lesions of the periarticular soft tissues, joints and intervertebral spaces, osteoporosis in the joints.
When used on the skin: skin tuberculosis, syphilis, bacterial, fungal, viral skin diseases, trophic ulcers of the leg, skin cancer, atheroma, nevus, melanoma, xanthoma, hemangioma, sarcoma, acne vulgaris and rosacea, post-vaccination skin reactions, in children under 1 years - rash with diaper rash.
Ear and eye drops: fungal diseases of the ear or eyes, acute viral diseases of the ear or eyes, tuberculosis of the eyes or ear (including a history), bacterial infections of the ear or eyes, glaucoma, defect or thinning of the corneal and scleral epithelium, perforation of the tympanic membranechronic or transferred otitis media.
Limit the use of betamethasone (parenterally and orally) for open-angle glaucoma, hyperlipidemia, hypoalbuminemia, viral and bacterial infections, syphilis, Itsenko-Cushing's disease, systemic osteoporosis, thrombophlebitis, obesity of 3-4 degrees; (intra-articular administration) the general serious condition of the patient, inefficiency or short duration of action of 2 past injections; (application to the skin) when applied to large areas or prolonged use - diabetes, cataracts, tuberculosis, glaucoma. For children during the growth period, take only by absolute indications.
Dosage
Betamethasone is used parenterally, orally, topically. Doses and route of administration depend on the disease and are selected individually. Inside, betamethasone is taken after a meal: the daily dose for children is 0.017-0.25 mg / kg, for adults 0.25-8 mg. After prolonged treatment, the dose is gradually reduced under the supervision of a doctor, every 3 days by 250 mcg. Parenteral, betamethasone disodium phosphate: - slowly, intravenously, by stream or by drop, in adults: single dose of 4–8 mg (up to 20 mg if necessary), followed by a maintenance dose of 2–4 mg. Betamethasone dipropionate - intramuscularly, deeply, for adults - 4-6 mg (up to 9 mg) per day. For children - intramuscularly, from 1 year to 5 years old - an initial dose of 2 mg, 6-12 years old - 4 mg. Periarticular and intraarticular (for adults): in large joints - 2–4 mg (up to 9 mg), small ones - 0.8–2 mg not more often than 1 time in 3 weeks; tendon sheaths - 0.4–1 mg, in a synovial bag - 2-3 mg; soft tissues - 2-6 mg; intradermally into the lesion - not more than 0.1 mg / cm2 and not more than 2 mg per week; if necessary, it can be mixed with local anesthetics (1% solution of lidocaine, procaine). In ophthalmology, subconjunctival: https://zentherapycenter.com/let-v/vitamin-b12-troy-for-sheep-and-cattle.php necessary, 2 mg is administered as a solution for injection. Topically: apply a thin layer and gently rub (cream, ointment) on the affected skin 2 to 6 times a day until clinical improvement, then 1-2 times a day; it is better to apply the cream on wet or moist areas, ointment - with dry scaly or lichen lesions. The course of therapy for children and patients with facial lesions is not more than 5 days. Ear and eye drops: for eye pathology, in the conjunctival sac - 1-2 drops of Betamethasone solution every 1-2 hours at the beginning of therapy, for diseases of the ear, in the external auditory canal - 2-3 drops of 0.1% solution every 2-3 hours, then, depending on the therapeutic effect, the frequency of administration is reduced.
If you skip the next dose of betamethasone, you should do this, as you recall, take it next time after the set time from the last time.
Mental disorders are likely in patients who have chronic diseases, are prone to the appearance of mental disorders and use large doses of the drug; such symptoms can occur up to 2 weeks 0.1% starting treatment. Betamethasone preparations are used with caution with herpes simplex, diabetes mellitus, systemic lupus erythematosus (the risk of aseptic necrosis increases), in patients with a risk of thrombosis, Valerate, in the elderly (risk of hypertension, osteoporosis, especially in the postmenopausal period in women), only with appropriate antibiotic therapy - with purulent infections, abscesses, tuberculosis. It is necessary to take into account the increased effect of cirrhosis of the liver, hypothyroidism, the possibility of developing relative adrenal insufficiency (within a few months after stopping the drug). With prolonged therapy, careful monitoring of the dynamics of development and growth of children is necessary, periodically examining the eyes (to detect cataracts, glaucoma and other pathologies), regularly monitoring the functioning of the hypothalamus-pituitary-adrenal system, glucose levels in urine and blood, serum electrolytes, the presence of latent blood in the stool. With systemic use, electroencephalography is recommended. Avoid contact with mucous membranes and eyes of dosage forms that are intended for skin. Avoid immunization and vaccination during treatment. It is not recommended to drink alcohol during treatment with betamethasone.
Side effects
The severity and frequency of development of adverse reactions depend on the size of the dose and the duration of treatment. Long-term therapy or high doses of glucocorticoids can lead to severe manifestations of prescription drugs - and glucocorticoid effects, which are considered as side effects.
Systemic reactions: sensory organs and nervous system: delirium (agitation, confusion, anxiety), euphoria, disorientation, hallucinations, depression, paranoia, manic / depressive episode, increased intracranial pressure and swelling of the optic nerve head, sleep disturbance, vertigo, dizziness, sudden loss of visionheadache, formation of subcapsular posterior cataract, increased intraocular pressure with possible damage to the optic nerve, steroid exophthalmos, glaucoma, the development of secondary viral or fungal infections second eye; blood and circulatory system: hypertension, chronic heart failure, hypercoagulation, myocardial dystrophy, thrombosis, ECG changes that are characteristic of hypokalemia; digestive system: vomiting, erosive and ulcerative lesions, pancreatitis, nausea, erosive esophagitis, changes in appetite, hiccups; metabolism: water retention and Na +, negative nitrogen balance due to protein catabolism, hypokalemia, weight gain; endocrine system: decreased adrenal cortex function, steroid diabetes, decreased glucose tolerance, Itsenko-Cushing's syndrome, manifestation of latent diabetes mellitus, growth retardation in children, hirsutism; support and movement system: muscle weakness, decreased muscle mass, spontaneous bone fractures, steroid myopathy, osteoporosis, tendon ruptures, aseptic necrosis of the femoral head; skin: steroid acne, thinning of the skin, striae, hypo- or hyperpigmentation, petechiae, delayed wound healing, ecchymosis, excessive sweating; allergic reactions: swelling of the face, stridor, urticaria, shortness of breath, rash, anaphylactic shock; other: decreased immunity, activation of infectious diseases, withdrawal syndrome (nausea, anorexia, lethargy, joint pain, back Valerate, muscle pain, abdominal pain, general weakness, and others), irregular menstruation.
With the introduction of betamethasone intravenously: arrhythmias, cramps, flushing.
When injected into the joints : increased pain. Local effects manx administered parenterally: burning, pain, numbness, infection and paresthesia at the injection site, atrophy of the subcutaneous tissue and skin, scar formation at the injection site.
When using betamethasone on the skin: itching, dryness and burning of the skin, hyperemia, erythema, striae, steroid acne, folliculitis, prickly heat, hypertrichosis, secondary infections, with prolonged use - local hirsutism, skin atrophy, telangiectasia, hypopigmentation, purpura, systemic manifestations are possible on large surfaces.
Ear and eye drops: increased intraocular pressure, the formation of a subcapsular posterior cataract, glaucoma, perforation or thinning of the sclera and cornea, tingling or burning in the ear, pain, irritation, burning and itching of the skin, the development of secondary infection, dermatitis, with prolonged use of large doses, systemic reactions are possible.
Interaction
Toxic and therapeutic effects component the inducers of liver enzymes, and increase oral contraceptives and estrogens, the possibility of hypokalemia and arrhythmias increase diuretics, digitalis glycosides, amphotericin B, carbonic anhydrase inhibitors; the possibility of ulcerative-erosive lesions or bleeding in the gastrointestinal tract is increased by non-steroidal anti-inflammatory drugs and alcohol; the risk of developing lymphomas and other lymphoproliferative diseases and the appearance of infections is enhanced by immunosuppressants, the possibility of developing pulmonary edema in present women increases erythrocytes. Reduces hypoglycemic activity of insulin and antidiabetic drugs, diuretic and natriuretic activity of diuretics, activity of vaccines; reduces anticoagulant activity of coumarin and indandion derivatives, streptokinase and urokinase, heparin. Enhances hepatotoxicity of paracetamol. Reduces blood levels of mexiletine and salicylates.
special instructions
Pregnancy and lactation
During pregnancy, betamethasone can be used if the expected benefit to the mother is higher than the possible risk to the fetus. With eclampsia, preeclampsia, symptoms of placental damage, it is contraindicated to use betamethasone. It is not recommended to be taken in large doses and often over a long period of time. Breastfeeding should be discontinued during betamethasone therapy.
Overdose
With an overdose of betamethasone, nausea, sleep disturbances, vomiting, euphoria, agitation occur. With prolonged use of high doses, osteoporosis, hypertension, fluid retention in the body and other symptoms of hypercorticism, including Itsenko-Cushing's syndrome and secondary adrenal insufficiency, appear. Treatment: gradual discontinuation of the drug, correction of electrolyte balance, maintenance of vital functions, taking antacids, phenothiazines, lithium preparations; with Itsenko-Cushing's syndrome - aminoglutethimide.
Release form
- Rr d / in. (betamethasone disodium phosphate / betamethasone dipropionate)
- Eye drops (in the form of disodium phosphate)
Mechanism of action
The anti-inflammatory effect is associated with inhibition of the release of inflammatory mediators by eosinophils; inducing the formation of lipocortins and reducing the number of mast cells that produce hyaluronic acid; with a decrease in the permeability of capillaries; stabilization of cell membranes and organelle membranes (especially lysosomal).
The anti-allergic effect develops as a result of suppression of the synthesis and secretion of allergy mediators, inhibition of the release of histamine and other biologically active substances, T- and B-lymphocytes from sensitized mast cells and basophils, a decrease in the sensitivity of effector cells to allergy mediators, inhibition of antibody formation, and changes in the body's immune response.
When exposed to eye tissue, a warning of the marginal accumulation of neutrophils occurs, which leads to a decrease in exudation, production of cytokines, inhibition of macrophage migration, which ultimately leads to a decrease in the processes of infiltration and granulation.
Main effects
- It has local anti-inflammatory, anti-allergic, decongestant and antiproliferative effects.
- It has a pronounced vasoconstrictor effect.
- Betamethasone disodium phosphate is a readily soluble compound that is well absorbed after parenteral administration to the tissue and provides a quick effect. Betamethasone dipropionate has a slower absorption. As a result of this combination, a double effect is achieved. Immediately after parabulbar injection, the fast component begins to act - medical phosphate, which immediately gives an anti-inflammatory and anti-allergic effect, manx after 1-2 days the slow-reacting component begins to act - betamethasone propionate, the effectiveness of which remains for 7-10 days. As a result of this, with a single injection, almost all the need for postoperative administration of corticosteroids is blocked against a background of stable 0.1% action.
Pharmacokinetics
After injection of the combined preparation of betamethasone disodium, phosphate is rapidly absorbed from the injection site and distributed in the body. The absorption of betamethasone dipropionate is slow, which ensures a long-term effect of the drug. disodium phosphate betamethasone is 1 Betamethasone after administration.
